Hildegard Peplau developed the interpersonal relations theory, which describes the phases of the nurse-patient relationship. The theory outlines 4 phases: orientation, identification, exploitation, and resolution. It also identifies key nursing roles to support patients through each phase towards achieving health goals. Peplau's theory emphasizes therapeutic communication between nurses and patients to understand their needs and collaboratively set plans. The theory provides a framework for the nursing process and remains applicable for supporting patients.

1. Interpersonal
Relations Theory
HILDEGARD
PEPLAU

2. Hildegard Peplau
Psychiatric Nurse of the Century
Born: September 1, 1909, Reading, Pennsylvania, United
States.
Education:
William Alanson White Institute(1954)
Pottstown Hospital, School of Nursing(1931)
Columbia University
Bennington College
 Worked tirelessly to advance nursing education and practice in
1930's.
Neuropsychiatric hospital in London,UK.
Member of the Army Nurse Corps
Worked at Bellevue and Chestnut Lodge Psychiatric Facilities
Died: March 17, 1999, Sherman Oaks, Los Angeles, California,
United States

4. Person
A man who is an organism that lives
in an unstable balance of a given
system.
Health
Symbolizes movement of the
personality and other ongoing human
processes that directs the person
towards creative, constructive,
productive and community living.
Environment
Forces outside the organism and in
the context of the socially-approved
way of living, from which vital human
social processes are derived such as
norms, customs and beliefs.
Nursing
Significant, therapeutic
interpersonal process. It functions
cooperatively with human
processes that present health as a
possible goal for individuals.

5. Interpersonal
Relations
Theory

6. Introduction to the Theory

7. Phases of Nurse-Patient Relationship
A.Orientation Phase
Get acquainted phase of the nurse-patient
relationship.
Preconceptions are worked through
Parameters are established and metEarly
levels of trust are developed
Roles begin to be understood
B.Identification Phase
The client begins to identify problems to be
worked on within relationship
The goal of the nurse: help the patient to
recognize his/her own
interdependent/participation role and promote
responsibility for self

8. C.Exploitation Phase
Client’s trust of nurse reached full
potential
Client making full use of nursing
services
Solving immediate problems
Identifying and orienting self to
[discharge] goals
D.Resolution Phase
•Client met needs
•Mutual termination of relationship
•Sense of security is formed
•Patient is less reliant on nurse
•Increased self-reliance to deal with own
problems

9. Both are sequential and focus on therapeutic relationship.
Both use problem solving techniques for the nurse and patient
to collaborate on, with the end purpose of meeting the patients
needs.
Both use observation communication and recording as basic
tools utilized by nursing.
Assessment:
•Data collection and analysis [continuous]·
•May not be a felt need.
Orientation:
Non continuous data collection.
Felt need ·
Define needs
Nursing diagnosis Planning:
•Mutually set goals.
Identification:
Interdependent goal setting
Implementation:
•Plans initiated towards achievement of
mutually set goals.
•May be accomplished by patient , nurse or
family.
Exploitation:
•Patient actively seeking and drawing help.
•Patient initiated
Evaluation:
•Based on mutually expected behaviors.
•May led to termination and initiation of
new plans
Resolution:
•Occurs after other phases are completed
successfully.
•Leads to termination.
Interpersonal Theory and Nursing Process

10. Interpersonal Therapeutic Process
This type of process is based on the theory
proposed by Peplau and particularly useful in helping
psychiatric patients become receptive for therapy.
Often referred as "Psychological Mothering," it
includes the following steps:
•The patient is accepted unconditionally as a participant
in a relationship that satisfies his needs;
•There is recognition of and response to the patient's
readiness for growth, as his initiative; and
•Power in the relationships shifts to the patient, as the
patient is able to delay gratification and to invest in goal
achievement.

11. NURSING
ROLES

12. • Stranger role
 Receives the client the same way one
meets a stranger in other life situations;
provides an accepting climate that builds
trust.
• Resource role
 Answers questions, interprets clinical
treatment data, gives information.
• Teaching role
 Gives instructions and provides training;
involves analysis and synthesis of the
learner's experience.

13. • Counseling role
 Helps client understand and integrate the
meaning of current life circumstances;
provides guidance and encouragement to
make changes.
• Surrogate role
 Helps client clarify domains of dependence,
interdependence, and independence and
acts on clients behalf as advocate.
• Active leadership role
 Helps client assume maximum
responsibility for meeting treatment goals
in a mutually satisfying way.
• Technical expert role
 Provides physical care by displaying clinical
skills; Operates equipment

14. 1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
Additional Roles:

15. • Person
• Health
• Environment
• Nursing
• Therapeutic Nurse-Client Relationship
Major Concepts:
Sub- Concepts:
• Roles of the nurse in the Therapeutic Relationship
• Anxiety
a. Mild
b. Moderate
c. Severe
d. Panic

16. Peplau’s work and characteristics of a theory
Interrelation of concepts
-Four phases interrelate the different
components of each phase.
Applicability
-The nurse patient interaction can apply
to the concepts of human being, health, environment and
nursing.
Theories must be logical in nature -
-This theory provides a logical
systematic way of viewing nursing situations
-Key concepts such as anxiety, tension,
goals, and frustration are indicated with explicit relationships
among them and progressive phases

17. Generalizability
-This theory provides simplicity in regard
to the natural progression of the NP relationship.
Theories can be the bases for hypothesis that can be tested
-Peplau's theory has generated testable
hypotheses.
Theories can be utilized by practitioners to guide and
improve their practice.
-Peplau’s anxiety continuum is still used
in anxiety patients
Theories must be consistent with other validated
theories, laws, and principles but will leave open
unanswered questions that need to be investigated.
-Peplau's theory is consistent with
various theories

18. Limitations
• Personal space considerations and
community social service resources are
considered less.
• Health promotion and maintenance
were less emphasized
• Cannot be used in a patient who doesn’t
have a felt need eg. With drawn patients,
unconscious patients
• Some areas are not specific enough to
generate hypothesis

19. • Nurse and patient can interact.
• Both the patient and nurse mature as the
result of the therapeutic interaction.
• Communication and interviewing skills
remain fundamental nursing tools.
• Nurses must clearly understand themselves
to promote their client’s growth and to
avoid limiting client’s choices to those that
nurses value.
Assumptions:

20. The phases provide simplicity
regarding the natural progression of
the nurse-patient relationship.
This simplicity leads to adaptability
in any nurse-patient interaction,
thus providing generalizability.
Strengths:

21. Weaknesses:
Health promotion and
maintenance were less
emphasized.
The theory cannot be used in a
patient who doesn’t have a felt need
such as with withdrawn patients.

22. •Hays .D. (1961). Phases and steps of experimental teaching
to patients of a concept of anxiety: Findings revealed that
when taught by the experimental method, the patients were
able to apply the concept of anxiety after the group was
terminated.
•Burd .S.F. Develop and test a nursing intervention framework
for working with anxious patients: Students developed
competency in beginning interpersonal relationship.
Research Based on Peplau’s Theory

23. • Peplau conceptualized clear sets of nurse’s roles that can be used by
each and every nurse with their practice. It implies that a nurse’s
duty is not just to care but the profession encompasses every
activity that may affect the care of the patient.
• The idea of a nurse-client interaction is limited with those
individuals incapable of conversing, specifically those who are
unconscious.
• The concepts are highly applicable with the care of psychiatric
patients considering Peplau’s background. But it is not limited in
those set of individuals. It can be applied to any person capable and
has the will to communicate.
• The phases of the therapeutic nurse-client are highly comparable to
the nursing process making it vastly applicable. Assessment
coincides with the orientation phase; nursing diagnosis and
planning with the identification phase; implementation as to the
exploitation phase; and lastly, evaluation with the resolution phase.
Conclusion